Here are some points to keep in mind as you continue your sex life during or after cancer treatment.
Learn as much as you can about the possible effects your cancer treatment may have on your sexuality. Talk with your doctor, nurse, or any other member of your health care team. When you know what to expect, you can plan how you might handle those issues.
Keep in mind that, no matter what kind of cancer treatment you have, you’ll still be able to feel pleasure when you are touched. Few cancer treatments (other than those affecting some areas of the brain or spinal cord) damage the nerves and muscles involved in feeling pleasure from touch and reaching orgasm. For example, women whose vaginas are painfully tight or dry can often reach orgasm through stroking of their breasts and outer genitals. For people with cancer, sexual touching is often satisfying. Pleasure and satisfaction are possible even if some aspects of sexuality have changed.
Try to keep an open mind about ways to feel sexual pleasure. Some couples have a narrow view of what sexual activity means to them. If both partners cannot reach orgasm through or during penetration, some may feel disappointed. But for people being treated for cancer, there may be times when intercourse is not possible. Those times can be a chance to learn new ways to give and receive sexual pleasure. You and your partner can help each other reach orgasm through touching and stroking. At times, just cuddling can be pleasurable. You could also continue to enjoy touching yourself. Do not stop sexual pleasure just because your usual routine has been changed.
Try to have clear, 2-way talks about sex with your partner and with your doctor. If you are too embarrassed to ask your doctor whether sexual activity is OK, you may never find out. Talk to your doctor about sex, and tell your partner what you learn. Otherwise, your partner might be afraid that sex might hurt you. Good communication is the key to adjusting your sexual routine when cancer changes your body. If you feel weak or tired and want your partner to take a more active role in touching you, say so. If some part of your body is tender or sore, you can guide your partner’s touches to create the most pleasure and avoid discomfort.
Boost your self-esteem. Remind yourself about your good qualities. If you lose your hair, you may choose to wear a wig, hat, or scarf if it makes you feel more comfortable. Some women prefer to wear nothing on their head. You may wear a breast form (prosthesis) if you have had a breast removed. Do whatever makes you feel good about yourself. Eating right and exercising can also help keep your body strong and your spirits up. Practice relaxation techniques, and get professional help if you think you are depressed or struggling.
How cancer treatment affects sexual desire and response
Lack of desire
Both men and women often lose interest in sexual activity during cancer treatment, at least for a time. At first, concern for survival is so great that sex may not be a priority. This is OK. Few people are interested in sex when they feel their lives are being threatened. When people are in treatment, loss of desire may be caused by worry, depression, nausea, pain, or fatigue. Cancer treatments that disturb the normal hormone balance can also lessen sexual desire.
If there’s a conflict in the relationship, one partner or both might lose interest in sex. Any emotion or thought that keeps a woman from feeling excited can interfere with desire for sex. Distracting thoughts can keep her from getting aroused. Her vagina then stays tight and dry, which can make vaginal penetration uncomfortable or painful.
Many people who have cancer worry that a partner will be turned off by changes in their bodies or by the very word “cancer.” These worries can affect desire, too.
Pain is a common problem for women during vaginal penetration (and/or intercourse). It’s often related to changes in the vagina’s tissues or size and vaginal dryness. These changes can happen after pelvic surgery, radiation therapy, menopause, or treatment that has affected a woman’s hormones.
Sometimes the pain sets off a problem called vaginismus. If a woman has vaginismus, the muscles around the opening of the vagina become tense without the woman being aware of it. This makes vaginal penetration difficult. Pushing harder increases the woman’s pain because her vaginal muscles are clenched in a spasm. Vaginismus can be treated with counseling and some special relaxation training. These treatments are described in the section called “Dealing with sexual problems.”
Another common way that cancer treatment can affect a woman’s sex life is by causing menopause earlier than expected. This is called premature menopause. Symptoms are often more abrupt and intense than the slow changes that happen during a natural menopause. When a woman’s ovaries are removed as part of a cancer surgery, or when the ovaries stop working because of chemotherapy or radiation to the pelvis, the loss of estrogen can cause hot flashes and vaginal atrophy (the vagina becomes tight and dry). Some women can take replacement hormones to help these problems. Women with cancers of the breast or uterus usually cannot take estrogen, but they may benefit from some of the suggestions discussed in the section called “Dealing with sexual problems.”
Women who have premature menopause sometimes have low androgen levels. This may be linked to lower sexual desire, but this link is not clear. Androgen (testosterone) hormone therapy has been shown to improve sexual function, but there are safety concerns that have kept the FDA from approving testosterone supplements for this purpose. Testosterone has not been studied in women with cancer.
If you are thinking of using hormones, it’s important to talk with your oncologist or nurse to learn about the benefits and possible risks of hormone therapy.
Women are usually able to have orgasms after cancer unless cancer or its treatment has damaged the spinal cord and caused the genital area to be numb. But even with spinal cord damage, there’s evidence that orgasm is possible, at least in some women.
Sometimes problems like pain during intercourse may distract a woman from reaching orgasm. In some cases, a woman might need to try different positions or types of genital touching. She might also need to practice having orgasms alone before going back to sex with a partner.